{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T10:21:28Z","timestamp":1783938088233,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T00:00:00Z","timestamp":1617753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005567","name":"H. Lee Moffitt Cancer Center and Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005567","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30\u2010CA076292"],"award-info":[{"award-number":["P30\u2010CA076292"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>For patients with sentinel lymph node (SLN)\u2010positive cutaneous melanoma, the Second Multicenter Selective Lymphadenectomy trial demonstrated equivalent disease\u2010specific survival (DSS) with active surveillance using nodal ultrasound versus completion lymph node dissection (CLND). Adoption and outcomes of active surveillance in clinical practice and in adjuvant therapy recipients are unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a retrospective cohort of SLN\u2010positive adults treated at 21 institutions in Australia, Europe, and the United States from June 2017 to November 2019, the authors evaluated the impact of active surveillance and adjuvant therapy on all\u2010site recurrence\u2010free survival (RFS), isolated nodal RFS, distant metastasis\u2010free survival (DMFS), and DSS using Kaplan\u2010Meier curves and Cox proportional hazard models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 6347 SLN biopsies, 1154 (18%) were positive and had initial negative distant staging. In total, 965 patients (84%) received active surveillance, 189 (16%) underwent CLND. Four hundred thirty\u2010nine patients received adjuvant therapy (surveillance, 38%; CLND, 39%), with the majority (83%) receiving anti\u2013PD\u20101 immunotherapy. After a median follow\u2010up of 11 months, 220 patients developed recurrent disease (surveillance, 19%; CLND, 22%), and 24 died of melanoma (surveillance, 2%; CLND, 4%). Sixty\u2010eight patients had an isolated nodal recurrence (surveillance, 6%; CLND, 4%). In patients who received adjuvant treatment without undergoing prior CLND, all isolated nodal recurrences were resectable. On risk\u2010adjusted multivariable analyses, CLND was associated with improved isolated nodal RFS (hazard ratio [HR], 0.36; 95% CI, 0.15\u20100.88), but not all\u2010site RFS (HR, 0.68; 95% CI, 0.45\u20101.02). Adjuvant therapy improved all\u2010site RFS (HR, 0.52; 95% CI, 0.47\u20100.57). DSS and DMFS did not differ by nodal management or adjuvant treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Active surveillance has been adopted for most SLN\u2010positive patients. At initial assessment, real\u2010world outcomes align with randomized trial findings, including in adjuvant therapy recipients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Lay Summary<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>For patients with melanoma of the skin and microscopic spread to lymph nodes, monitoring with ultrasound is an alternative to surgically removing the remaining lymph nodes.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>The authors studied adoption and real\u2010world outcomes of ultrasound monitoring in over 1000 patients treated at 21 centers worldwide, finding that most patients now have ultrasounds instead of surgery.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Although slightly more patients have cancer return in the lymph nodes with this strategy, typically, it can be removed with delayed surgery.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Compared with up\u2010front surgery, ultrasound monitoring results in the same overall risk of melanoma coming back at any location or of dying from melanoma.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.33483","type":"journal-article","created":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T15:29:21Z","timestamp":1617809361000},"page":"2251-2261","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Active surveillance of patients who have sentinel node positive melanoma: An international, multi\u2010institution evaluation of adoption and early outcomes after the Multicenter Selective Lymphadenectomy Trial II (MSLT\u20102)"],"prefix":"10.1002","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4679-4665","authenticated-orcid":false,"given":"Kristy Kummerow","family":"Broman","sequence":"first","affiliation":[{"name":"Department of Cutaneous Oncology H. Lee Moffitt Cancer Center Tampa Florida"},{"name":"Department of Oncologic Sciences University of South Florida Morsani School of Medicine Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasha","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Michigan Ann Arbor Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesly","family":"Dossett","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Michigan Ann Arbor Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Cutaneous Oncology H. Lee Moffitt Cancer Center Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0550-9335","authenticated-orcid":false,"given":"Dennis","family":"Kirichenko","sequence":"additional","affiliation":[{"name":"Department of Oncologic Sciences University of South Florida Morsani School of Medicine Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Carr","sequence":"additional","affiliation":[{"name":"Department of Cutaneous Oncology H. Lee Moffitt Cancer Center Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avinash","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Surgery Memorial Sloan Kettering Cancer Center New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0923-153X","authenticated-orcid":false,"given":"Edmund K.","family":"Bartlett","sequence":"additional","affiliation":[{"name":"Department of Surgery Memorial Sloan Kettering Cancer Center New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda A. G.","family":"Nijhuis","sequence":"additional","affiliation":[{"name":"Department of Surgery Melanoma Institute Australia The University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Surgery Melanoma Institute Australia The University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4277-8692","authenticated-orcid":false,"given":"Tina J.","family":"Hieken","sequence":"additional","affiliation":[{"name":"Department of Surgery Department of Oncology Mayo Clinic Rochester Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Kottschade","sequence":"additional","affiliation":[{"name":"Department of Surgery Department of Oncology Mayo Clinic Rochester Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Downs","sequence":"additional","affiliation":[{"name":"Division of Cancer Surgery Peter MacCallum Cancer Center Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Gyorki","sequence":"additional","affiliation":[{"name":"Division of Cancer Surgery Peter MacCallum Cancer Center Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Stahlie","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology Netherlands Cancer Institute Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"van Akkooi","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology Netherlands Cancer Institute Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Ollila","sequence":"additional","affiliation":[{"name":"Department of Surgery University of North Carolina Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill","family":"Frank","sequence":"additional","affiliation":[{"name":"Department of Surgery University of North Carolina Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1822-303X","authenticated-orcid":false,"given":"Yun","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9321-2795","authenticated-orcid":false,"given":"Giorgos","family":"Karakousis","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Moncrieff","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Norfolk and Norwich University Hospital Norwich United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Nobes","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Norfolk and Norwich University Hospital Norwich United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Vetto","sequence":"additional","affiliation":[{"name":"Department of Surgery Oregon Health &amp; Science University Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dale","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Surgery Oregon Health &amp; Science University Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M.","family":"Farma","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Fox Chase Cancer Center Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremiah L.","family":"Deneve","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Tennessee Memphis Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin D.","family":"Fleming","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Tennessee Memphis Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew C.","family":"Perez","sequence":"additional","affiliation":[{"name":"Department of Surgery Emory University Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4853-7352","authenticated-orcid":false,"given":"Michael C.","family":"Lowe","sequence":"additional","affiliation":[{"name":"Department of Surgery Emory University Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Olofsson Bagge","sequence":"additional","affiliation":[{"name":"Department of Surgery Sahlgrenska Center for Cancer Research Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Mattsson","sequence":"additional","affiliation":[{"name":"Department of Surgery Sahlgrenska Center for Cancer Research Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann Y.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery NYU Langone Health New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell S.","family":"Berman","sequence":"additional","affiliation":[{"name":"Department of Surgery NYU Langone Health New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harvey","family":"Chai","sequence":"additional","affiliation":[{"name":"Discipline of Surgery Faculty of Health and Medical Sciences School of Medicine University of Adelaide Royal Adelaide Hospital Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidde M.","family":"Kroon","sequence":"additional","affiliation":[{"name":"Discipline of Surgery Faculty of Health and Medical Sciences School of Medicine University of Adelaide Royal Adelaide Hospital Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juri","family":"Teras","sequence":"additional","affiliation":[{"name":"Surgery Clinic North Estonia Medical Center Foundation Tallinn Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland M.","family":"Teras","sequence":"additional","affiliation":[{"name":"Surgery Clinic North Estonia Medical Center Foundation Tallinn Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norma E.","family":"Farrow","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Durham North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Beasley","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Durham North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2628-0720","authenticated-orcid":false,"given":"Jane Yuet Ching","family":"Hui","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Minnesota Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Been","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology University Medical Center Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Schelto","family":"Kruijff","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology University Medical Center Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youngchul","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Cutaneous Oncology H. Lee Moffitt Cancer Center Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syeda Mahrukh Hussnain","family":"Naqvi","sequence":"additional","affiliation":[{"name":"Department of Cutaneous Oncology H. Lee Moffitt Cancer Center Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amod A.","family":"Sarnaik","sequence":"additional","affiliation":[{"name":"Department of Cutaneous Oncology H. Lee Moffitt Cancer Center Tampa Florida"},{"name":"Department of Oncologic Sciences University of South Florida Morsani School of Medicine Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vernon K.","family":"Sondak","sequence":"additional","affiliation":[{"name":"Department of Cutaneous Oncology H. Lee Moffitt Cancer Center Tampa Florida"},{"name":"Department of Oncologic Sciences University of South Florida Morsani School of Medicine Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan S.","family":"Zager","sequence":"additional","affiliation":[{"name":"Department of Cutaneous Oncology H. Lee Moffitt Cancer Center Tampa Florida"},{"name":"Department of Oncologic Sciences University of South Florida Morsani School of Medicine Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1245\/ASO.2006.03.058"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.25444"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1613210"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/CMR.0b013e32833716f9"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)00141-8"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.18.02306"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)70122-1"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1611299"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1802357"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1709030"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1708539"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0169-2607(93)90013-B"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1214\/aos\/1176350951"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1999.10474144"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2019.12.010"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02557364"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMe1704290"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.25298"},{"issue":"16","key":"e_1_2_8_20_1","first-page":"4338","article-title":"Abstract 4338: Immunotherapy in resected stage III melanoma: an analysis of the National Cancer Database. Proceedings: AACR Annual Meeting 2020; June 22\u201024, 2020; Philadelphia, PA","volume":"80","author":"Moyers JT","year":"2020","journal-title":"Cancer Res"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.75.7724"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-018-6812-z"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2019.37.15_suppl.9590"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djq455"},{"key":"e_1_2_8_25_1","first-page":"CD012806","article-title":"Ultrasound, CT, MRI, or PET\u2010CT for staging and re\u2010staging of adults with cutaneous melanoma","volume":"7","author":"Dinnes J","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.2217\/mmt-2019-0003"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/CMR.0000000000000344"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2018.02.022"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.33483","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cncr.33483","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.33483","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T15:45:23Z","timestamp":1760283923000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.33483"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,7]]},"references-count":27,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2021,7]]}},"alternative-id":["10.1002\/cncr.33483"],"URL":"https:\/\/doi.org\/10.1002\/cncr.33483","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,7]]},"assertion":[{"value":"2020-05-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}